Editors face a surprising number of ethical problems

About a year ago the BMJ decided to form an ethics committee to help us with the increasing number of ethical problems we face.1 The chairman and members were appointed last year,2 and the committee met for the first time at the end of last year. Interested readers will find the minutes on bmj.com, along with a paper on how the committee works and what it does. One gratifying feature of the first meeting was that our committee endorsed broad approaches—for example, about consulting authors over ethical worries and consent—that BMJ editors had already adopted.

The ethics committee's business will be as transparent as possible. The manuscripts under discussion are confidential, however, so we have anonymised them to protect authors' privacy. The UK's Committee on Publication Ethics takes the same approach in its annual report.3

We discussed eight papers at the first meeting, all referred by BMJ editors concerned about some aspect of the design, conduct, or implications of a report. All but two were case reports or case series, not formal research. These kinds of papers cause particular problems because they are never submitted for ethical review, don't count as research, contain identifiable patient details, and often conclude that things could have been managed better (often by someone else). Case series reporting clinical “experimentation” with different drugs or doses are equally problematical. When does the routine tinkering with treatments or surgical procedures become so unorthodox that it's unethical? Titrating …